location of unhealthy tissue within the breast and often result in removal of a relatively large amount of healthy tissue as well.

During ductoscopy, the surgeon threads a hollow tube about 1 mm in diameter into the affected milk duct. The tube enables the surgeon to view the duct lining directly on a television monitor to locate and inspect the unhealthy tissue. It also serves as a guide to remove the abnormal duct. The technique spares as much normal breast tissue as possible and leaves patients with less pain and numbness.

Dietz, along with colleagues at The Cleveland Clinic Foundation, tested ductoscopy on 119 women with PND. Ducts affected by PND become dilated and enlarged, which simplifies insertion of a ductoscope. The procedure was successful in 87 percent of participants. Four percent showed signs of breast cancer and the remainder were diagnosed with polyps and other benign disorders.

Seventy patients received both a ductogram and ductoscopy. Ductograms identified abnormalities in 53 of these women while ductoscopy revealed abnormalities in 63 patients.

This suggests that we can localize abnormalities better with ductoscopy than we can with ductograms, says Dietz.

In addition, ductoscopy revealed multiple abnormalities deep within the breast that likely would have been missed and left behind using standard procedures, she says.

Next, Dietz will apply ductoscopy to women without PND who are at high risk for breast cancer. If that study is successful, she says, it may one day be possible to treat these cancers with chemotherapy applied only to the duct.

Ductoscopy may become valuable not only for the detection and diagnosis of breast cancer but also for its early treatment, says Dietz.

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